ABOUT US | A leading regional player in the retail insurance sector, Coralisle Group Ltd., with over 600 employees and offices in Bermuda, the Bahamas, Barbados, the British Virgin Islands, the Cayman Islands, Turks report achievements and addresses underperformance. Ensure compliance with applicable healthcare regulations, contractual requirements, and company policies. Identify opportunities for process improvement, automation, and operational efficiencies. Support claims fraud detection, investigation, prevention, and recovery activities. Work closely with Operations Manager to assist in managing remote consultants. Allocate work and resources to ensure operational objectives are achieved. Adjudicate staff claims and claims requiring management approval or special handling. Review and negotiate provider reimbursement arrangements and discount opportunities where applicable. Assist with provider and facility relationship management initiatives. Lead and participate in strategic projects, technology enhancements, and business process improvement initiatives. Support audit, compliance, risk management, and governance activities. Undertake other duties as assigned to support the operational objectives of CG Coralisle Medical Insurance. Communicate departmental goals, expectations, and performance standards, and manage employee performance through regular coaching, feedback, performance appraisals, development planning, attendance management, and corrective action, as required. Identify training and development needs, coordinate onboarding activities, and provide leadership, coaching, mentoring, and development opportunities for claims employees. Partner with Senior Managers to support workforce planning, recruitment, retention, onboarding, employee relations, and staffing strategies necessary to meet operational requirements. THE PERSON | To be the ideal candidate you must have: Minimum of 10 years’ medical claims experience, including local and international claims adjudication. Demonstrated experience managing high-volume medical claims operations. Extensive knowledge of medical, dental, vision, prescription drug, life, and disability benefits. Strong understanding of healthcare reimbursement methodologies, provider contracting, utilization management, and medical cost containment strategies. Strong knowledge and current proficiency in ICD-10, CPT, ADA, ODA coding systems and medical terminology. Knowledge of HIPAA and other healthcare privacy regulations is considered an asset. Experience participating in healthcare industry committees, Bermuda Health Council initiatives are highly desirable. Strong leadership, coaching, communication, analytical, organizational, decision-making, problem-solving, and strategic thinking skills. Ability to interpret complex medical documentation, work effectively under pressure and manage multiple priorities. Strong English and mathematics skills. Advanced proficiency in Microsoft Office applications and business systems. THE BENEFITS | We value our employees and offer a supportive and inclusive work environment. We provide opportunities for professional growth and development, competitive compensation, and a comprehensive benefits package. #J-18808-Ljbffr
Claims Manager
